3 week old questions - Growth spurt??

Hi, I'm new to the forum and am a FTM. I want to thank you in advance for your help.

My DD is just over 3 weeks old. I EBF, except for one 2oz bottle of breast milk at night that my husband gives her. I started pumping last week in order to build my supply for when I go back to work. In a 24 hour period I generally pump 2-6oz (depending on how often I pump), by pumping after she is done eating and while my husband gives her the bottle.

She normally eats every hour to 2 hours during the day and every 3-4 hours at night. Sunday night I fed her at 8 and then my husband gave her a 2oz bottle at 10. I went to bed at 9 and when I got up at 2 to feed her (this was the longest stretch of sleep I’ve had in well over a month); it was the first time that I could tell that my breasts were engorged and very full. I have never been that swollen before. She ate her fill and I was still able to pump about 2 oz; same at the 6am feeding. Then all day yesterday, it did not feel like I have gotten full and at almost every feeding, she pulled from the breast and started crying, like she hadn’t gotten enough. Is this a growth spurt?? I had a breakdown because I feel like I'm not producing enough to feed my daughter. I just started taking 2 610mg fenugreek pills 3x/day on Saturday.

Also, in the last 2 days, whenever I pump I barely get anything. But when I quit and try to hand express, I still have quite a bit more milk. Could it be that the pump doesn’t have enough suction or could the shields be too small??

Her Info:
She weighed 8lbs 9oz at birth, was back to her birth weight at day 10, and at day 21 she weighed 9lbs 4.8oz.
She has 6 or more wet diapers and 3 or more dirty diapers (today included).
We use a pacifier, because she is a comfort nurser and my nipples were raw from her just suckling.
She also seems to have colic (inconsolable from 7:30 until 10 nightly) and she is either really gassy or has mild acid reflux. We generally give gas drops after almost every feeding.
Her latch is not the greatest but it works. I usually have to pull her lips out and the latch seems shallow. She cries when I try to get her to take more. I normally wear a size C bra and my boobs have gotten a lot bigger.

Re: 3 week old questions - Growth spurt??

If she is transferring milk ok, its unlikely that she'd stop doing so in a day. More likely a growth spurt, or I say this gentle...no problem at all just a fussy day. Try not to worry about how your breasts feel-more or less engorged. Watch diaper output and growth patterns and do as you are doing which is feed baby on demand. You seem to be doing a great job, hang in there, growth spurts are tough but all you can do is feed constantly and all will be ok!

Re: 3 week old questions - Growth spurt??

Probably a growth spurt. But it concerns me a bit that the latch is bad enough that you feel raw. Is hands-on help from a lactation consultant, preferably an IBCLC, possible for you? A consult with a LC could help you fix your LO's latch (sometimes it's simply a matter of positioning), and also help you with pumping, since the LC will be able to tell you whether or not your shields are the right size and whether or not your pump is working as it should.

Just FYI, when supply and demand are well-matched you're rarely if ever going to feel full and you'll probably have a little more challenge pumping. Most moms start out making more milk than their babies need, and that usually means they often feel full and pump a lot of milk with very little effort. But that state of affairs doesn't last because the body doesn't want to waste energy making extra milk, and because making extra puts you at increased risk of plugged ducts and mastitis. So eventually your supply adjusts to meet baby's needs very precisely, at which point you stop feeling full and can't pump as much. And when that adjustment takes place, your baby may act quite fussy because all of a sudden she has to work harder for her meals.

Re: 3 week old questions - Growth spurt??

Hi and welcome to the forum! Congratulations on your new baby daughter.

I actually think there may be a problem. But not of low production. You do not have low milk production!

The problem is your nipples are sore and so you are pumping 1-3 times a day(?) baby is getting a bottle a day, and using a pacifier. None of this is a good idea this early, even the small amount you are doing. And why it is not a good idea is because it can lead to exactly what is happening here, the engorgement, the fussyness at the breast, and, probably worst of all, you having these doubts about your ability to nourish your baby.

Of course your baby is a comfort nurser. Virtually all babies nurse for comfort. This is normal and needed. As are very frequent feedings, (at least 10 times a day-minimum) cluster feedings, long feedings, nursing to sleep-all Normal and usually needed, especially in the first 2 months. Uneeded pumping, pacifiers and bottles especially in the early weeks get in the way of normal breastfeeding and may throw it all off.

But Nursing should not hurt. Your nipples should not be getting sore from long sessions or frequent nursing at this point.

This simply suggests something is up with latch or positioning. These are fixable problems. The fastest route would be to see a good IBCLC who is experienced in helping mothers and babies this age or older find comfortable nursing positions and latch. Make sure the professional you see has this type of experience! If the IBCLC has only worked with brand newborns in the hospital she may not have the skills you need. Ask.

Or you can work on it yourself. If you would like suggestions, tell us about a typical nursing session, including your baby's behavior, your position and baby's position, and how it feels.

Also if you are not using a nipple cream like lanolin regularly, that may help with healing the nipples. But the reason for the soreness in the first place must be addressed.

Re: 3 week old questions - Growth spurt??

Thanks for the input so far.

My nipples aren't raw anymore. They were the first week. Now it just "hurts" a little bit when she first starts. I just have some slight cracking on one side. I use lanolin oil when I remember to put it on.

A typical session:
I feed on demand or wake her up every 2-2.5 hours
I change her diaper before hand to help wake her up
I usually switch which side I start with, but lately my left side has felt less productive - so I have been starting on that side first (this is the side that has the cracks).
I use the cross-over hold to get a latch and then usually position into a cradle hold or let her rest on a boppy.
I try to let her feed until she delatches herself on the first side. I attempt to burp and then re-offer the same side at least once more before I switch.
She drinks hard for the first 5 mins or so - I can easily hear her swallow. She often sputters/coughs and I sit her up until it passes and then re-offer the same side.
I try to keep her eating by rubbing her back, blowing in her face, tickling her feet and legs. Most often she falls asleep and lets go on her own - except for yesterday which is why it was such a shock when she started crying.

I feel like I should mention that she has started fighting sleep. You can tell she is just exhausted but fights and fights going to sleep. Once she does fall asleep she will sleep for at least an hour or more.

I started pumping this early mainly to get enough to give her one bottle a day. It's for more bonding time with my husband; once he started going back to work, when he got home she would only cry when he took her. I wanted her to relate food from him as well as help establish a bedtime routine since he normally gives it at the 10:00pm feeding. It's nice then because we know she is nice and full and lets us both sleep for a longer stretch - which is much needed for me. Plus, I was hoping it would help increase my supply so I could build a stock pile for when I go back to work.

We've been using a pacifier since the hospital and giving the one bottle for over a week - and yesterday was the first time we've had a problem. Today has been going a little better - she's been sleeping like crazy and I have had to wake her up for every feeding.

I have tried the football hold with some success - although neither of us like it. It's too awkward for me and I can tell she is uncomfortable with it as well.

Re: 3 week old questions - Growth spurt??

I am going to start at the bottom of your post first, because It sounds as if you don't think the bottles or the pacifier could be the problem. That's fair. Certainly I could be wrong, you are there and I am not. I can only go by what you have posted, and what those events sound like to me. But I want to clarify WHY these things cause breastfeeding problem in so many cases, according to breastfeeding experts including lactation consultants and doctors, it has been written about frequently and even studied.

We've been using a pacifier since the hospital and giving the one bottle for over a week - and yesterday was the first time we've had a problem. Today has been going a little better - she's been sleeping like crazy and I have had to wake her up for every feeding.

The problems caused by pacifiers and bottles are not going to occur overnight. That does not mean they are not the problem.

Pacifiers keep babies asleep longer, or, if awake, "content' and not asking to nurse. That is what they are designed to do. Sucking on a pacifier releases the same hormone that is released when a baby nurses that tells the baby they are full. This is why, Pacifier overuse HAS been linked to poor weight gain and low production (That is not happening in your case-yet.)

So baby sleeps through when they would normally cue. So then baby needs to be awoken to nurse, which means a cranky baby who has difficulty latching, which may lead to latch pain, nipple soreness, and a difficult feed. Also, baby not nursing frequently enough (due to pacifying) leads to engorgement in mom.

Pumping when is not necessary increases milk production too much, possibly leading to engorgement, over production, and forceful letdown, which may leas to coughing, gasping general fussiness at the breast and also can affect latch as baby will clamp.

Engorgement alone can cause latch issues as it is harder for baby to latch on a very full breast.

Having even the occasional bottle allows baby to associate comfort and satiety with something else besides the breast, which it is best to avoid when breastfeeding is just getting started. Also babies are routinely overfed with bottles, or the milk comes very quickly and with baby having no control over the flow, as baby does at the breast. This can cause the baby to become frustrated on the breast. It can also cause baby to compress mom’s nipple as he does wiht a bottle nipple exacerbating latch pain.

Re: 3 week old questions - Growth spurt??

My nipples aren't raw anymore. They were the first week. Now it just "hurts" a little bit when she first starts. I just have some slight cracking on one side. I use lanolin oil when I remember to put it on.

Good. This suggests things are improving as time goes by and you and baby both get more practiced which is great. But really, the norm is that the nursing mother can nurse, even a newborn, with NO pain and NO nipple damage. So that is what you are working toward.
A typical session:

I feed on demand or wake her up every 2-2.5 hours

Does baby still need to be awoken in order to nurse at least 10 times a day? This is typical in the first two weeks but less so, later.

I change her diaper before hand to help wake her up

What if instead you nursed as soon as possible and saved the diaper change for later? Babies do not need to be particularly awake in order to nurse. In fact they can nurse quite well in their sleep! Changing the diaper or any unnecessary delay between cue and breast may cause baby to be cranky at the start of the feed. Generally, calm babies latch more easily and comfortably.

I usually switch which side I start with, but lately my left side has felt less productive - so I have been starting on that side first (this is the side that has the cracks).

The typical advice when there is nipple damage is to start baby on the least sore side first. Your baby is gaining appropriately and making plenty of diapers from what you report. So production appears fine. Some differences in production between breasts is normal and not something to be concerned about usually. Are you making baby nurse on both sides per session or is that babies choice? If baby only wants to nurse on one side at a time that is fine. And THEN you switch to the other side for the next feeding.

I try to let her feed until she delatches herself on the first side. I attempt to burp and then re-offer the same side at least once more before I switch.
She drinks hard for the first 5 mins or so - I can easily hear her swallow. She often sputters/coughs and I sit her up until it passes and then re-offer the same side.

Ok that sounds fine. Maybe a little forceful letdown is indicated. Also, unless the burping is helping in some way there is no reason to do it in the middle of a feeding like that. Or possibly, ever. If a baby has a little air bubble trapped and they are uncomfortable they will certainly let you know and then helping baby burp is a good idea. But it need not be this automatic thing in most cases.

I try to keep her eating by rubbing her back, blowing in her face, tickling her feet and legs. Most often she falls asleep and lets go on her own - except for yesterday which is why it was such a shock when she started crying

. Why are you trying to keep her eating? are you thinking a nursing session has to be a certain length of time?

I feel like I should mention that she has started fighting sleep. You can tell she is just exhausted but fights and fights going to sleep. Once she does fall asleep she will sleep for at least an hour or more.

Typically after the first two weeks or so, a baby who has been able to sleep with great ease-maybe even sleeping TOO much- begins to WAKE UP! This developmental change manifests in many ways (wanting to nurse more, crying/fussing more, and yes, having a much harder time going to sleep.) Babies prefer to be comforted to sleep in the loving arms of mom or dad. Baby can want to be nursed to sleep, walked to sleep, bounced to sleep (mom or dad on exercise ball), rocked to sleep, swayed to sleep, etc. This is where the need for all those lullabies come from. Some babies just do fuss and cry to sleep for a time. It's normal, and if mom or dad is comforting them into sleep, that is what the tired baby needs.

I started pumping this early mainly to get enough to give her one bottle a day. It's for more bonding time with my husband; once he started going back to work, when he got home she would only cry when he took her. I wanted her to relate food from him as well as help establish a bedtime routine since he normally gives it at the 10:00pm feeding. It's nice then because we know she is nice and full and lets us both sleep for a longer stretch - which is much needed for me.

Yes. many people introduce bottles for this reason. With some it goes smoothly, for others it is an issue.

If this is what you want to do, that is your choice, you are the expert on your family and their needs. But I would suggest that many many fathers have figured out just fine how to bond with their babies and give mom a needed break/assistance etc. without taking over the job that biology gave to mom. A supportive dad is vital in these situations. But he has special things only HE can do for baby. And he is there to support mom. Breastfeeding is the special thing only YOU can do.

But Plus, I was hoping it would help increase my supply so I could build a stock pile for when I go back to work.

When do you return to work? In A week, a month-longer? It makes a big difference how much time you have how much you need to pump each day or even if you need to pump each day. Here is what a working mom typically will need: Enough milk in the fridge or freezer for the first day back, and a little extra for emergencies. You may need more to feel comfortable, that is fine. But you do not need a huge stash! This is because you will pump at work and on that first day pump enough for the next day. You don’t need to increase you milk production in your body beyond what is normal, which is what you will do with this pumping now, while you are with your baby. That causes oversupply and will cause some of the issues you have been seeing (fussy at the breast, coughing, engorged, etc.) You do not have to build up extra production before going back to work. You just need normal production. Which you prepare for the return to work best by eliminating the pain and soreness so you can simply nurse and relax with your baby.

Re: 3 week old questions - Growth spurt??

OK, finally, latch & positioning issues! It sounds like you have not tried laid back positioning or sidelying. Or if you have, it has not worked. Sometimes these ideas need lots of tweaking before mom and baby find their 'fit.' so I suggest, keep trying. Remember with laid back it is not necessary that mom is laying down! That is just the name. Nursing while leaning back, even slightly, in a comfortable position, is 'laid back.'

The key with positioning is FORGET THE RULES. All you need is baby at the breast taking milk and mom comfortable-all over, because you are going to be nursing a lot. So if the position you are using is causing you to hunch or strain your back, shoulders or neck, or hold baby or your breast up at an unnatural height, try something else that lets your body parts be where they naturally go, you are supported and relaxed, and baby is supported and relaxed and comfortable on you. If the pillow is working for you, great, but I have seen nursing pillows cause sore nipples on many occasions as they lift baby to a place that is not normal breast height or cause hunching by mom. Adjust as needed.

These are my favorite latch and positioning links-I have tried to include things with pictures and a video. I hope you get some ideas here.

Re: 3 week old questions - Growth spurt??

Thanks for the advice. I've been working on her latch and that really seemed to help.

I also think I've figured out the problem. I am pretty sure she has thrush. I noticed her tongue was white earlier this week, but I thought it was just milk residue. She was really not herself today so I started looking closer and realized that the white never went away. She cries when she feeds and keeps breaking away, even though she is obviously hungry. Last night I noticed that my nipples had a burning sensation which got worse after I fed her (I had thought it was from engorgement). I'll be calling our doctor in the morning.

I have read on a couple of websites that all stored milk collected while I have thrush needs to be discarded. Other sites have said this is not necessary. Thoughts??